Job Snapshot

Job Description

About The Position:

The Claims Quality Control Auditor will work under the direction of the Supervisor of Claims Quality Control and be responsible for supporting quality initiatives through a variety of auditing activities. These activities include but are not limited to the review of work performed in the Claims departments. The person hired in this role will contribute in the identification of opportunities to improve work processes and collaborate in the development of solutions to problems found in the work that is audited. This is a key role in the successful operations of the claims processing.

Position Responsibilities:

Review work done by various departments, including Claims, Network Operations and Network Development

Consistent and methodical review according to established guidelines

Meet all deadlines (weekly/monthly/quarterly) for review of work

Clearly state what is identified as a deficiency or error in work being reviewed

Work proactively with the Manger/Director of Claims Quality Control to ensure quality recommendations are made and implemented

Research and assist to define regulatory or accreditation requirements as needed

Other Duties as assigned

Position Requirements:

Education: Bachelors preferred

Licenses: Certification in auditing, or certification/licensure related to the functional areas being audited would be beneficial

Relevant Work Experience: Minimum of 1 year experience in a Managed Healthcare setting (with a strong understanding or Managed Healthcare operations, background in behavioral health would be beneficial)

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled